意外胆囊癌45例的诊断与治疗

摘要

Objective To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC).Methods The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery,Xin Hua Hospital,Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28.9％) and 34 females(71.1％),aged 68 years(range:27 to 68 years).And there were 20 cases who aged above 70 years.Twenty-four cases were diagnosed preoperatively as cholecystolithiasis plus chronic cholecystitis.Ten cases were diagnosed preoperatively as cholecystolithiasis plus actue cholecystitis.Six cases were diagnosed preoperatively as cholecystolithiasis plus choledocholith.Six cases were admitted because of gallbladder polyp and 1 case was admitted because of gallbladder adenomyomatosis.Results Thirty-four patients with UGC received radical surgery.Among them,11 patients experienced postoperative complication and no posterative mortality occoured during hospital stay.Thirteen patients were diagnosed with T1b UGC,the harvested lymph node of Nx,N0,N1 and N2 was 2,9,1 and 1,respectively.In addition,2 cases were identified to have local-regional tumor recurrence during our rescue radical surgery.The median overall survival time of the patients who did not receive radical surgery was 7 months(range:2-56 months).Nevertheless,the median overall survival time for patients diagnosed with T1,T2 and T3 tumors who received radical surgery,was 41 months(range:19-82 months),33.5 months(range:31-36 months) and 17 months(range:7-46 months),respectively.Conclusions For patients with UGC,rescue radical surgery can achieve a better survival time.Furhtermore,our experience proved that rescue radical surgery for UGC is safe and feasible.Therefore,rescue radical surgery should be performed in patients with diagnose with UGC especially those T1b patients.%目的 探讨意外胆囊癌的诊断和治疗方式.方法 回顾性分析2008年1月至2017年12月上海交通大学医学院附属新华医院普通外科收治的45例意外胆囊癌患者的临床病理学资料.男性11例(28.9％),女性34例(71.1％),中位年龄68岁(范围:27～ 86岁),其中70岁以上者20例(44.4％).术前诊断为胆囊结石伴慢性胆囊炎24例,胆囊结石合并急性胆囊炎10例,胆囊结石伴胆总管结石6例,胆囊息肉4例,胆囊腺肌症1例.结果 45例患者中,行根治性手术切除34例,中位出血量150 ml(范围:50～800ml).病理学诊断为腺癌44例、腺鳞癌1例.发生围手术期并发症11例,其中肺部感染3例、肺部感染合并胸腔积液1例、切口感染2例、胆肠吻合口漏1例、胆总管缺血致胆瘘合并中心静脉导管感染1例,所有并发症均经过内科治疗及超声引导下穿刺引流等介入治疗治愈.接受根治性手术的患者中,T1期患者术后中位生存时间为41个月(范围:19～ 82个月),T2期患者中位生存时间为33.5个月(范围:31～36个月),T3期患者中位生存期为17个月(范围:7～46个月),T4期1例,生存时间为7个月;未接受根治性手术的患者术后生存时间为7个月(范围:2～56个月).结论 根治手术是目前意外胆囊癌的最主要治疗方式,其治疗意外胆囊癌安全可行.T1b的胆囊癌患者病理学结果明确后应行根治性手术.